Rosacea

Rosacea is a chronic rash involving the central face that most often affects those aged 30 to 60. It is common in those with fair skin, blue eyes and Celtic origins. It may be transient, recurrent or persistent and is characterised by its colour, red.

There are several theories regarding the cause of rosacea, including genetic, environmental, vascular and inflammatory factors. Skin damage due to chronic exposure to ultraviolet radiation plays a part.

What are the clinical signs of rosacea?

Rosacea results in red spots (papules) and sometimes pustules. They are dome-shaped rather than pointed and unlike acne, there are no blackheads, whiteheads or nodules. Rosacea may also result in red areas, scaling (rosacea dermatitis) and swelling.

Characteristics of rosacea include:

  • Frequent blushing or flushing

  • A red face due to persistent redness and/or prominent blood vessels – telangiectasia (the first stage or erythematotelangiectatic rosacea)

  • Red papules and pustules on the nose, forehead, cheeks and chin often follow (inflammatory or papulopustular rosacea); rarely, the trunk and upper limbs may also be affected

  • Dry and flaky facial skin

  • Aggravation by sun exposure and hot and spicy food or drink (anything that reddens the face)

  • Sensitive skin: burning and stinging, especially in reaction to make-up, sunscreens and other facial creams

  • Red, sore or gritty eyelid margins including papules and styes (posterior blepharitis), and sore or tired eyes (conjunctivitis, keratitis, episcleritis) – ocular rosacea

  • Enlarged unshapely nose with prominent pores (sebaceous hyperplasia) and fibrous thickening – rhinophyma

  • Firm swelling of other facial areas including the eyelids – blepharophyma

  • Persistent redness and swelling or solid oedema of the upper face due to lymphatic obstruction – Morbihan disease

how is rosacea diagnosed?

In most cases, no investigations are required and the diagnosis of rosacea is made clinically. Occasionally a skin biopsy is performed, which shows chronic inflammation and vascular changes.